Blog

Patience
and persistence are the key watchwords. Despite much confusion,
delays in Open Enrollments, especially for ACA (Affordable
Care Act, aka ObamaCare) through Cover Oregon, we're ahead
of most states. So there's plenty of time before mid December to
enroll, let things get ironed out. Getting your benefits right is
paramount; and remember, you can always change plans annually, if
advisable.

Those
on Medicare or Medicaid are exempted from,
don't need to shop the Cover Oregon marketplace; it's mainly for
folks under age 65 (& legal residents of any age who don't
qualify for Medicare). Group or individual grandfathered plan members
may either keep their plans, or shop the exchange.

Traditional Medicare
Supplements with underwriting (health questions) are available
year around. The new Open Enrollment period for Medigap or
Supplements, as of 2013, the Oregon Birthday Rule, runs annually
from 30 days before to 30-60 days after your birthday. You can then
change to the same or lesser plan without any health questions, to
save premium with another Company. Luckily, I took several clients
with me last year to support the Birthday Rule at its Salem hearing;
I was the only agent there, though some mailed in their support too.

Medicare
Part C medical plans, HMOs Health Maintenance
Organizations like Kaiser, PPOs Preferred Provider
Organizations like Regence, & Part D Rx plans, the
so called "advantage" plans have an Open Enrollment period
annually from Oct 15 - Dec 7th, to change or drop plans. Besides
premiums, they have varying deductibles & co-pays that can run
several thousand dollars annually. They offer a limited list of
preferred providers, some cover drugs, are easy to apply for, yet
often only cover emergencies outside their areas. HMOs require
primary doctor referrals to specialists, while PPOs don't; services
cost less inside their networks, more outside them. A
last dis-enrollment period runs from Jan 1 - Feb
14th annually.

Cover
Oregon, Oregon's health insurance exchange, isn't yet fully
functional, as to actually verifying subsidies or online enrollments,
but should be soon, perhaps in days or weeks, before the December
15th enrollment deadline. Still, one can get a good idea of
what's available online now, then sign up through your certified
agent or navigator, or by yourself soon. Applications on paper are
available, but they are long & cumbersome, as are applications
via phone, due to privacy issues. Extended open enrollment runs until
3/31/2014.

Here's
a few tips: eligibility for subsidies or tax credits is determined by
tax filing status. If you're low income, under 100-138% of FPL
Federal Poverty Level ($15,856/individual; $32,499/family of 4),
especially if you get food stamps, you can sign up for OHP Oregon
Health Plan via a 1 page fast track form. Folks with incomes above
subsidy levels will soon have a short enrollment form option. The
rest need to qualify via income, taxes, long form. Whatever plan you
consider, be sure your doctors are in their network. Some plans like
Moda & Lifewise have large, existing state networks; some are
new, possibly without track records.

Here
are the ways to get health plans: through your employer, or
individually, either inside or outside the exchange; or stay with
your grandfathered plan, if preferable. Tax credits are only
available through the exchange; tax deductions, outside it. If
qualified, tax credits can be advanced monthly to offset premiums.
See your tax professional for details. Many people can be helped by
these plans; fewer will face financial problems, like bankruptcy.
Consider your choices carefully, and shop wisely.

Paco
Maribona, Certified Senior Advisor, He may be
reached at 541-764-5155.